14-9000

104-10117-
( 7-10075) | 2025 RELEASE UNDER THE PRESIDENT JOHN F. KENNEDY ASSASSINATION RECORDS ACT OF 1992 |

a

SECTION 1.

Submit in duplicate. Answer all questions completely. If question does not apply, write “NA.” Write “UNKNOWN?” only if you do not
know-the answer and it cannot be obtained from personal records. If additional space is required use extra pages the same size as this
page and sign each such page. Reference each continued item by “section and item number to which it relates.

. FULL NAME (Last-first-middle ) 2-DATE OF BIRTH] 3.PLACE OF BIRTH (City,State,Country)
Flores, Daniel :
. PRESENT STATUS (Single, widowed, divorced, or annulled) SPECIFY: Married 12
S. STATE DATE, PLACE. AND REASON FOR ALL DIVORCES OR ANNULMENTS

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SECTION 11. SPOUSE
1. NAME OF SPOUSE (last- first-middle-maiden) + DATE QF BIRTH 3. PLACE OF BIRTH (spouse)

Flores, (Dorothy Arnettyob 0481 Jan 1935 Portland, Oregon

4. DATE AND PLACE OF MARRIAGE . C\TIZENSHIP OF SPOUSE (Tf naturalized. indicate date & place
18 November 1960 . reaneegee e-
USA

6. STATE DATE, PLACE. AND REASON FOR ALL SEPARATIONS. DIVORCES OR ANNULMENTS

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7. OCCUPATION 8. PRESENT EMPLOYER
Legal Secretary (Arnold and Porter) 0%

9. EMPLOYER'S OR BUSINESS ADORESS (No., Street, City, State & Zip Code - Country if not U.S.)

: (0)
(229 19th)Street NW, Washington, D.C.

SECTION Lil. RESIDENCE (Since date of last PHS, if overseas residence indicate only city and country)
ADDRESS - LAST RESIDENCE FIRST (number, street, city,state,country) Jngl, oh + INCLUSIVE DATES (month & year)

(Guayaquil, Ecuador | (0 May 1969 |May 1971

Feb. 1974

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Sept. 197

+3 .
ienna, va (8151 Larkin La.) | gen. 1974

SECTION IV. CHELDREN AND OTHER DEPENDENTS (Provide information for all children and dependents )
ob (Kendra) Flores 3 March 1971 F usa | $151 Larking La
= . Washington D Vienna a
o6 (Zola Marie)Flores 15 March 1974 USA fe
San ons
(4)

FORM OBSOLETE PREVIOUS

12-70 ute EDITIONS

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14.90000

, RELATIVES BY BLOOD, MARRIAGE OR ADOPTION WHO EITHER (1) LIVE A
SECTION V. °° + (2) ARE NOT U.S. CITIZENS OR (3) WORK FOR A FOREIGN ‘GOVERNMENT 7 ..
: "y- "(Last-First-Middle) . . 2. : 7 City, State, Country)
"GUERRERO || Richard, Nephew” 3 “i BIRTH “ew “orleans ; La y,
5. CITIZENSHIP (Country) 6- ADDRESS OR COUNTRY IN WHICH RELATIVE RESIDES —— :
1) USA Ansbach, Germany

+ EMPLOYED BY
Army

NAME (Last-First-Middle) A

ote ey - .

FREQUENCY QF CONTACT
‘Periodic

"wire reve

2. -RELAT S}ONSHIP 3. DATE OF BIRTH [4

5. CITIZENSHIP (Country) ; ADDRESS OR COUNTRY IN WHICH RELATIVE RESIDES
(2) ; .

7. EMPLOYED BY 8. FREQUENCY OF CONTACT 9. DATE OF LAST CONTACT

1. NAME (Last-First-Middle ) 2. RELATIONSHIP 3. DATE OF BIRTH] 4-PLACE OF BIRTH (City, State ,Coumtry)

5. CITIZENSHIP (Country) 6. ADDRESS OR COUNTRY IN WHICH RELATIVE RESIDES

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SECTION VI. PERSONAL DECLARATIONS

1. HAVE YOU BEEN ARRESTED. INDICTED, OR CONVICTED FOR ANY VIOLATION OF LAW (Other than for YES (explain X -
minor traffic, yiolation) SINCE THE .DATE OF YOUR LAST PHS below)
ei? 49) E.! : R . tow)

2. SINCE THE DATE OF YOUR LAST PHS, HAVE THERE BEEN ANY UNFAVORABLE INCIDENTS IN YOUR wire) | (explain

WHICH MIGHT REQUIRE EXPLANATION. below)

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3. NAME OF YOUR PRESENT IMMEDLATE SUPERVISOR (include Room Number and Extension) Mr. Nestor “Sanchez Vw
. : X—74 RM 3.0 _
SECTION Vil. PERSONS TO BE NOTIFIED IN CASE OF EMERGENCY =~ <P

1. NAME (Last-First-Middle) as previous PHS 2. RELATIONSHIP

3. HOME ADDRESS (Number, Street, City, gtate, zip Code) \ tous 4. HOME TELEPHONE NUMBER

5S. BUSINESS ADDRESS (Number, Street, City, State, ZIP Code)-1NDICATE NAME OF FIRM| 6. BUSINESS TELEPHONE NUMBER & EXT.
OR EMPLOYER, |F APPLICABLE

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7. IN CASE OF EMERGENCY, OTHER CLOSE RELATIVES (spouse, mother, father ...) MAY ALSO BE NOTIFIED. IF SUCH NOTIFICATION
1S NOT DESIRABLE BECAUSE OF HEALTH OR OTHER REASONS, PLEASE IDENTIFY THE PERSONS NOT TO BE NOTIFIED AND THE REASON.

ISECTION VIII. > ADDITIONAL REMARKS .

DATE SIGNATURE OF EMPLOYEE

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14.90000

1. NAME (Pirest-middle-last )

Pau (rem) a

th oF vember

CITY AND STATE .

DATE TO DATE “NUM Pa . CITY. AND STATE

Se “HAVE YOU BEEN -ARRESTED.. IND IGTED /7OR “CONVICTED FOR -ANY-VIOLATION OF LAW (Other than for .- Explai
_sinor ‘traffic violation). -SANCE ‘THE DATE .OF YOUR -LAST. PHS . | Beis) P "

6. SINCE THE “DATE OF YOUR LAST. PHS, HAVE THERE BEEN ANY. UNFAVORABLE INCIDENTS | iN YOUR LIFE YES (Explai /
WHICH MIGHT REQUIRE EXPLANATION . ~ : . below)
: inst

H 7 Piery OF Be" Nahoney’ ‘IMMEDIATE SUPERVISOR

8. ADDITIONAL REMARKS (USE reverse if necessary)

29 Joisk 967

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tected me ot . We te ee ee ee ee

14.90000

1. NAME (First-middle- last )
Daniel (nm) Flores
3..:1F MARRIED

PLACE OF MARRIAGE
ima, Peru to

SINCE (Date). _| NUMBER AND STREET.

: 08....
August 1961. 828 Connecticut ive., NAW,

DATE TO DATE NUMBER AND STREET

DATE TO DATE... NUMBER AND STREET

HAVE YOU BEEN ARRESTED. -INDICTED, -
minor traffic violation) SINCE THE DATE OF YOUR LAST PHS

WHICH MIGHT REQUIRE EXPLANATION
NAME OF YOUR PRESENT IMMEDIATE SUPERVISOR

Harry T, Mahoney

ADDITIONAL REMARKS (Use reverse if necessary)

-CTURN PHS:
“12 @ HEADQUARTERS.”

Cy EMPLOYEE

Form!
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